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COVID-19 Heroine: Dr. Matshidiso Moeti

EJS Center / COVID-19 Response  / Spotlight a COVID-19 Heroine / COVID-19 Heroine: Dr. Matshidiso Moeti

Dr. Matshidiso Moeti

Dr. Matshidiso Moeti has had a long and distinguished career in public health and is currently serving her second term as the World Health Organization (WHO) Regional Director for Africa. Breaking new ground as the first woman to ever hold this position, Dr. Moeti led the WHO’s response to the Ebola outbreak in West Africa during her first term in the position. Prior to joining the WHO, Dr. Moeti worked on curbing the HIV/AIDS epidemic, first as the Head of the HIV/AIDS Unit in the Ministry of Health of Botswana, her home country, then with the Joint United Nations Programme on HIV/AIDS (UNAIDS) as Team Leader of the Africa and Middle East Desk in Geneva, then as head of the WHO Regional Office for Africa’s HIV/AIDS program. Most recently, Dr. Moeti has been working throughout the COVID-19 pandemic to connect leaders across the African continent and develop a coordinated response.

Dr. Moeti’s COVID-19 response efforts have clearly made an impression on her staff and colleagues. Out of all the nominations we received during our “Spotlight a COVID-19 Heroine” campaign, more than one third were for Dr. Moeti. The nominations came from a total of 25 different countries across Africa. This is, by far, the largest number of nominations received for one nominee and from the widest geographic scope, reflecting the profound impact Dr. Moeti has had on the continent as a whole in her role as WHO Regional Director.

We spoke with Dr. Moeti to learn more about the path that led her to become a public health leader, the impact of the COVID-19 pandemic across Africa, and the foundations that are needed to improve public health across the continent moving forward.

Read our interview with Dr. Moeti and watch highlights from our discussion below.

 

Dr. Moeti discusses her journey in public health leadership.

Q: You are a physician, a public health specialist, and you are currently serving your second term as Regional Director of the World Health Organization’s Regional Office for Africa. Could you talk about your career and your journey in leadership so far?  

When I was a teenager, the last thing I wanted to be was a doctor; both of my parents were doctors and I wanted to be different. I started to pursue physics, but it didn’t really grab me in the way I’d hoped. So, when it came time to decide, I thought I may as well study medicine as I’d heard so much about it from my parents.

I attended medical school in London, studying first at the Royal Free Hospital School of Medicine and working at the Royal Free Hospital. When I returned to Botswana, I worked at a district hospital there. This was a formative time that really shaped and influenced my work in the future: my first public health role was working as a junior doctor running the TB ward. This was an unpopular place to work where patients often stayed for months, and at that time our treatments weren’t as good as they are now. Beyond treating people, I became aware of the effects of their socio-economic situations when we tried to trace their contacts to stop the spread, and it was rewarding work when we made a difference beyond treating a patient’s physical ailment.

My next step was to transfer to a national hospital to train as a specialist. I was working in a pediatric ward where there was still a connection to public health. A large proportion of Botswana’s population are migrant laborers, and with so many people living and working far from home, this often resulted in fractured social structures. Men would go away for many years to work in mines, relationships would break down, and this had an effect on family structures. There was a high teenage pregnancy rate, resulting in many children coming in with malnutrition: in many cases, the father was gone, the mother had to drop out of school, there were financial difficulties, and the baby couldn’t be properly fed. That’s when I started to understand that things happen to people because of their life circumstances, and these circumstances must be addressed and dealt with in order to have good health overall.

Unfortunately, I realized that I wasn’t going to be able to pursue pediatric specialty training as this would have required me to be away from my own young family for a long time, so instead, I took a year to complete my master’s in public health with a focus on occupational health, obtaining an MSc in Community Health for Developing Countries from the London School of Hygiene and Tropical Medicine. When I returned to Botswana, I became head of the Ministry of Health’s Occupational Health Unit, where I worked on prioritizing workers’ health in the public health system. Much of our work was focused on public workplaces, farming areas, and on returning miners, coming back from working in mines in South Africa, who had health issues. Now, South African mining companies have been required to compensate ex-employees for the damage done to their health through working in the mines.

After that role, I began working on HIV at the time when Botswana had the highest HIV infection rate in the world. This was a very challenging period. I worked with the United Nations Children’s Fund (UNICEF) as Regional Health Advisor for East and Southern Africa, then with the Joint United Nations Programme on HIV/AIDS (UNAIDS) as Team Leader of the Africa and Middle East Desk in Geneva, before returning to Africa, where I joined the WHO Regional Office for Africa. I worked my way up through the organization before being elected to the WHO Regional Director role for the first time in 2015.

Q: At the beginning of your first term, in 2015, many West African countries were dealing with an Ebola outbreak. Your appointment and the subsequent launch of the WHO Health Emergencies Programme are credited with helping to combat the spread of Ebola. What was it like coming into your role during the time of the Ebola outbreak? What takeaways from this experience have you used to inform or guide your response to COVID-19? 

It was massively challenging beginning this role as Ebola was ravaging West Africa. One of the first things I did was travel to Guinea and Liberia to experience what things were like on the ground, where I learned several things that have proved to be important dealing with the COVID-19 pandemic and public health more broadly.

The first is that we must have public health systems in place that are present throughout a country and are resilient enough to contain and control any outbreaks quickly. Ebola started in a remote area of Guinea and therefore was able to spread quickly and quietly amongst vulnerable communities before anyone noticed it. That is why we need systems in place that not only treat diabetes, heart disease, and other illnesses, but that can be switched on and scaled up quickly in an emergency. We have to invest in the gaps before the pandemic hits. It’s not enough to pour in money when an emergency happens—the capacity to deal with it must already be in place.

There is also a political component to health. It’s not enough to have great doctors, nurses and scientists; you also need good political leaders and decision-makers who are aware of the risks. And it’s to their benefit to understand these risks, as what threatens a nation’s health also threatens the economy, and in turn, their political standing.

Ebola also showed us the wider impact of improving people’s health. When people were able to wash their hands more and practice better hygiene, not only did we manage to control Ebola, but we also saw reductions in cases of other diseases such as cholera. This showed us how important clean water and good sanitation is, and how giving everyone access to them should be a common goal. People themselves are central to the success of all actions. I respect enormously the capacity of African communities to play their part once they understand, and if they are appropriately supported.

International solidarity was also very important during Ebola, as it is again now. It’s a multilateral approach that helps to develop vaccines and therapeutics at speed. It’s still a work in progress, as wealthy countries are able to buy up the vaccine production capacity for COVID-19, while we’re still waiting to see what will be available for our countries.

 

Dr. Moeti on what it was like coordinating Africa’s response to COVID-19. 

Q: Throughout the pandemic, you have been working with local and international partners and governments to ensure synergy and efficiency in COVID-19 response efforts across Africa. Could you give us some insight into what goes into developing and managing response plans for the 47 different nation states that are in the WHO’s Africa region? What have been the biggest challenges? What do you feel has been your greatest achievement? 

The COVID-19 pandemic has been a unique experience—Ebola mainly affected just three countries and that was difficult to deal with, so to have all nation states affected is a huge challenge. However, several things have helped us respond. Firstly, fast political decision making has helped with early lockdowns to stop the spread—leaders listened to the advice from the WHO and the African Union based on what was happening elsewhere in the world.

Many African countries were also primed to respond quickly to COVID-19, as they deal with outbreaks all the time. Temperature checks at airports were already standard. We were also able to educate people quickly on how to respond, running many remote training webinars to equip regional healthcare workers.

Partnerships have been key to our response. We worked with the UN and other agencies on not just health issues, but also on procurement, supplies, and logistics. For example, UNICEF have lent their expertise and capacity to help us in our communication efforts, and the World Food Programme has played a critical role in logistics. African countries vary greatly, and many can’t compete for attention on the world stage, so we need help with obtaining and distributing supplies. We also need countries to invest in research that is most relevant to our public health needs.

There has also been an outpouring of partnerships with the private sector. I’ve seen inspiring work from young African innovators on projects such as solar powered water pumps to improve hygiene in public areas, as well as private companies repurposing by-products or materials to produce hand sanitizer, face masks, and other personal protective equipment (PPE). I’m certain this is something we can carry into the future.

Finally, partnerships across the African Union have produced great results when scientists and innovators have worked together. When the pandemic began, only two African countries had laboratories that could diagnose COVID-19, but thanks to knowledge sharing and collaboration across borders and sectors, now every country in Africa has this capacity. This shows us that it’s worth investing in research and giving people the space to improve public health. It also teaches us that we should combine our knowledge, our resources, and our capacity so that we can prepare now for whatever the next shock may be.

Q: You are the first woman ever to hold the position of WHO Regional Director for Africa, and you have made concerted efforts to include women at all levels of society in pandemic response. Could you talk about some of the actions you have taken to ensure the inclusion of more women as you worked to combat COVID-19?

Before the pandemic, we were already addressing gender parity at the WHO, especially at senior levels, as part of our transformation agenda. We have a leadership training program in place to train and mentor young women so that they can achieve their goals and rise in the organization.

Throughout the pandemic we have also focused on developing opportunities for women. Over half of the first group of UN volunteers working with WHO across Africa are women who are working in regional and country office teams. This is the first step to becoming a permanent part of the WHO, and we want to effectively provide these young women with the opportunity to create a career path for themselves.

I’m also involved in projects and organizations that encourage women to seek leadership positions in global health. The Women in Global Health Group is working to mobilize women in leadership and create networks for them. There is also the Women Lift Health program, which finds women already working in public health and helps them to develop in the system: improving their leadership skills, building confidence, and empowering them to go after roles that reflect their capacity. There is still work to be done with regard to getting more women into high-level leadership positions within public health institutions. It is the context, organizations, and policies of these institutions that need to be reconsidered and re-evaluated so that women are able to achieve their full potential. I hope that by the time I reach the end of my second term as Regional Director, we will see concrete, sustainable results on this front.

 

Dr. Moeti on how COVID-19 has impacted women across Africa.

Q: As the WHO Regional Director for Africa, can you share any insights about the impacts of COVID-19 on women across Africa? How does the impact on women differ from the impact on men?  

COVID-19 has had a profound impact on women. When I look at the data in Africa, I can see that many more men than women have been infected, which is a reflection on who is being more exposed to the virus. Men are more likely to work and travel outside the home, so their risk of becoming infected is increased. But the effects of COVID-19 on women are also huge. Firstly, it is mostly women who are health workers and caregivers, and the impact is not just becoming ill because of the challenges in obtaining PPE, but also the fear of getting ill and not being safe at work. Worrying that you may take the illness home to your family is a huge emotional burden.

COVID-19 has also had a major economic impact on women, many of whom work in informal and service sectors, or as domestic workers. When lockdowns were enforced, these women immediately lost their income. Women also have largely had to bear the impact of schools being closed and trying to juggle child care with work. This has placed a huge burden on women, and it has revealed some of the changes that need to be made. We really need to implement a safety net for people who work in the informal sector and recognize the value of women’s work at home as well as in the workplace.

Healthwise, we have seen big upticks in gender-based violence during the lockdowns; combining frustrations of being locked up at home with loss of income has exacerbated already violent situations. There has also been an increase in sexual abuse and increases in unplanned pregnancies—a lifelong impact—while access to family planning was limited during lockdowns.

 

Dr. Moeti on some of the lessons that can be learned from COVID-19.

Q: Looking ahead at the potential longer-term impacts of COVID-19 on women’s health in Africa, what measures do you think will be most important to prioritize in the months and years ahead? Is there anything you want more people to know about COVID-19 prevention and protection?  

Firstly, it would be great if the penny finally dropped—health is not an expense to an economy. It’s often seen as a non-productive sector, but healthy people are vital to economic development—not just people doing physical work, but people innovating to allow an economy to grow.

Secondly, that a virus can shut down economies and cause massive drops in GDP, because it destroys jobs, should be a huge wake up call to encourage investment in a resilient health system. The cost of investing in health bears no comparison to the cost required to mitigate a pandemic when no systems are in place. We have noted this in the past, and I just hope that this time it is taken up. Equity is a smart investment. It’s not just ideology or politics. If you don’t take care of the most vulnerable members of a society, the whole society will become vulnerable.

While lockdowns bought us time, they came at a very high price, particularly for the most vulnerable communities. We need mechanisms in place to support those people. For example, Botswana has a well-established drought response mechanism that can activate quickly when needed and give people an income for their basic needs. We need to prioritize a similar mechanism with respect to public health.

Finally, we need more and better partnerships with the private sector. It would be great if this is picked up on not only in health but in other sectors. Establishing partnerships with the private sector will help to speed up the industrialization of African systems, such as expanding solar power and access to electricity in remote areas which will also support healthcare in those regions.

Q: Going forward, what will be most important for countries in Africa to prioritize in order to build back better post-COVID-19?

COVID-19 vaccines hold so much promise for us all, but we need bold, decisive action and global solidarity in order to have access to them. Now is the time for African countries and African leaders to mobilize to find the financial resources so that we can put a plan in place to deploy the vaccine across the continent. I understand that the pandemic has already had a huge financial impact on countries, but if grants are not available then we must find other ways to access the finance required. Waiting will only increase our vulnerability. Also, funding is needed not only for acquiring vaccine supplies, but for delivery operations reaching every corner of countries. Building back better means sustaining some of the excellent experiences and developments—partnerships, links between people at the grass-roots level and their networks with decision-makers—to ensure actions are informed by real experiences.

Q: Working through such an immensely challenging time, how do you find focus, balance, and manage to maintain a positive attitude?

I’ve found inspiration in many places—from our hardworking teams, who are working on the ground day and night in tough situations, who just keep working so enthusiastically. I’m also inspired by seeing the sacrifices people have made; while it was tough, so many people realized the importance of staying at home and doing the right thing for the greater public good.

Over the course of this pandemic, I’ve made sure to keep in touch with family and loved ones, and friends, even when we couldn’t see each other in person, which has really helped me. I stopped traveling and resumed listening to jazz, exercising whenever I can. And I’m now hopeful and determined that we can take the progress that has been made during the COVID-19 pandemic into the future.